Beginning With the End in Mind: Contextual Considerations for Scaling-Out a Community-Based Intervention

Introduction: A number of effective physical activity programs for older adults exist, but are not widely delivered within community settings, such as the Cooperative Extension System. The purpose of this paper was to determine if an evidence-based intervention (EBI) developed in one state Extension system could be scaled-out to a new state system.Methods and results: The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework was used to guide an iterative evaluation of three translational stages. Stage 1: Before program adoption, Extension health educators were surveyed and interviewed to assess physical activity programming perceptions and factors that may influence their decision to attend training or deliver the program in practice. Results indicated that a virtual, scalable training protocol would be necessary and that training needed to include hands-on instruction and be catered to those who were less confident in physical activity program delivery. Stage 2: Training attendees were surveyed pre- and post-training on factors related to the adoption-decision making process and contacted post-training to assess program delivery status. Training did not influence perceptions of the program, intent to deliver, or confidence in delivering the program. Stage 3: During program implementation, the program was evaluated through the RE-AIM framework by surveying across three key stakeholder groups: (1) program participants, (2) potential delivery personnel, and (3) Extension administrators. Findings indicate that the program has the potential to reach a large and representative proportion of the target audience, especially in rural areas. However, adoption and implementation rates among Extension health educators and community partners were low and data collection for effectiveness, implementation, and maintenance was a challenge.Conclusion: Overall, the results indicate initial struggles to translating and evaluating the program in a large, rural state. Implications for practice include making system-level changes to increase physical activity program adoption rates among Extension health educators and improve data collection and program evaluation through this community-based organization. More work is needed to identify infrastructure support and capacity to scale-out EBIs

Dissemination in Extension: Health Specialists’ Information Sources and Channels for Health Promotion Programming

In the National Cooperative Extension System (herein: Extension), state-level specialists serve as key intermediaries between research, educators, and the community members they serve. There is a need to understand information seeking and sharing practices (i.e., dissemination) among specialists to increase the adoption of evidence-based health promotion programs. Specialists (N = 94) across 47 states were identified and invited to participate in this mixed methods study. A one-way ANOVA with Bonferroni corrections was used to analyze survey data. Data collected through semi-structured interviews were analyzed using an immersion crystallization approach. Forty-seven health specialists completed the survey representing 31 eligible states (65%) and were predominately female (89%), Caucasian (70%), had a doctorate (62%), and were employed within Extension for 10.2 + 9.7 years. The information sources used most frequently were academic journals and other specialists, and most used email and online meetings to communicate. Qualitative findings support the use of other specialists as a primary source of information and indicate specialists’ desire for an on-demand, bi-directional, online national repository of Extension programs. This repository would facilitate the dissemination of evidence-based programming across the system and reduce program duplication as well as information burden on county-based educators

Additional file 2: of Informing the development and uptake of a weight management intervention for preconception: a mixed-methods investigation of patient and provider perceptions

Provider survey. Survey distributed (electronically) to providers to capture their practices related to weight control and preconception interventions. (DOCX 150 kb

A Quasi-Experiment to Assess the Impact of a Scalable, Community-Based Weight Loss Program: Combining Reach, Effectiveness, and Cost

BACKGROUND: Primary care addresses obesity through physician oversight of intensive lifestyle interventions or referral to external programs with demonstrated efficacy. However, limited information exists on community program reach, effectiveness, and costs across different groups of participants. OBJECTIVE: To evaluate a scalable, community weight loss program using reach, effectiveness, and cost metrics. DESIGN: Longitudinal pre-post quasi-experiment without control. PARTICIPANTS: Enrolled participants in Weigh and Win (WAW), a community-based weight loss program. INTERVENTION: A 12-month program with daily social cognitive theory-based email and/or text support, online access to health coaches, objective weight assessment through 83 community-based kiosks, and modest financial incentives to increase program reach. MAIN MEASURES: Number of participants, representativeness, weight loss achievement (3%, 5% of initial weight lost), and cost of implementation. KEY RESULTS: A total of 40,308 adults (79% women; 73% white; BMI = 32.3 +/- 7.44, age = 43.9 +/- 13.1 years) enrolled in WAW. Women were more likely than men to enroll in the program and continue engagement beyond an initial weigh-in (57% vs. 53%). Based on census data, African Americans were over-represented in the sample. Among participants who engaged in the program beyond an initial weigh-in (n = 19,029), 47% and 34% of participants lost 3% and 5% of their initial body weight, respectively. The average duration for those who achieved 5% weight loss was 1.7 +/- 1.3 years. African American participants were more likely to achieve 5% weight loss and remain enrolled in the program longer compared to non-African American participants (2.0 +/- 1.3 vs. 1.6 +/- 1.2 years). Implementation costs were $2,822,698. Cost per clinically meaningful weight loss for African Americans ($257.97/3% loss; $335.96/5$318.62; $431.10) and Caucasians ($313.65; $441.87), due to the higher success rate of that subgroup of participants. CONCLUSIONS: Weigh and Win is a scalable technology-supported and community-based weight loss program that reaches a large number of participants and may contribute to reducing health disparities

Primary Care and Community-Based Partnerships to Enhance HPV Vaccine Delivery

Introduction/Objectives: With growing vaccination misinformation and mistrust, strategies to improve vaccination communication across community-based settings are needed. Methods: The Rural Adolescent Vaccine Enterprise (RAVE), a 5-year (2018-2022) stepped-wedge cluster randomized study, tested a clinic-based practice facilitation intervention designed to improve HPV vaccination. An exploratory aim sought to explore the use of partnerships between primary care clinics and a community partner of their choosing, to implement a social marketing campaign related to HPV immunization. We assessed perceptions about the value and success of the partnership, and barriers and facilitators to its implementation using a 29-item community partner survey, key informant interviews, and field notes from practice facilitators. Results: Of the initial 45 clinics participating in RAVE, 9 were unable to either start or complete the study, and 36 participants (80.0%) were actively engaged. Of these, 16/36 clinics (44.4%) reported establishing successful partnerships, 10 reported attempting to develop partnerships (27.8%), and another 10 reported not developing a partnership (27.8%), which were often caused by the COVID-19 pandemic. The most common partnership was with public health departments at 27.3%. Other partnerships involved libraries, school districts, and local businesses. More than half (63.7%) reported that creating messages regarding getting HPV vaccination was moderately to very challenging. Just under half reported (45.5%) that messaging was hard because of a lack of understanding about the seriousness of diseases caused by HPV, parents being against vaccines because of safety concerns, and religious values that result in a lack of openness to HPV vaccines. Community partners’ health priorities changed as a result of RAVE, with 80% prioritizing childhood immunizations as a result of the RAVE partnership. Conclusions: Community groups want to partner with primary care organizations to serve their patients and populations. More research is needed on how best to bring these groups together

sj-docx-1-jpc-10.1177_21501319241231405 – Supplemental material for Primary Care and Community-Based Partnerships to Enhance HPV Vaccine Delivery

Supplemental material, sj-docx-1-jpc-10.1177_21501319241231405 for Primary Care and Community-Based Partnerships to Enhance HPV Vaccine Delivery by Patricia A. Carney, Marie B. Engstrom, Chrystal Barnes, NithyaPriya Ramalingam, Caitlin Dickinson, Cort Cox, Laura K. Ferrara, Paul M. Darden, Lyle J. Fagnan, Miguel Marino and Brigit A. Hatch in Journal of Primary Care & Community Health</p

Recommendations for strengthening the role of embedded researchers to accelerate implementation in health systems: Findings from a state-of-the-art (SOTA) conference workgroup

BackgroundTraditional research approaches do not promote timely implementation of evidence-based innovations (EBIs) to benefit patients. Embedding research within health systems can accelerate EBI implementation by blending rigorous methods with practical considerations in real-world settings. A state-of-the-art (SOTA) conference was convened in February 2019 with five workgroups that addressed five facets of embedded research and its potential to impact healthcare. This article reports on results from the workgroup focused on how embedded research programs can be implemented into heath systems for greatest impact.MethodsBased on a pre-conference survey, participants indicating interest in accelerating implementation were invited to participate in the SOTA workgroup. Workgroup participants (N&nbsp;=&nbsp;26) developed recommendations using consensus-building methods. Ideas were grouped by thematic clusters and voted on to identify top recommendations. A summary was presented to the full SOTA membership. Following the conference, the workgroup facilitators (LJD, CDH, NR) summarized workgroup findings, member-checked with workgroup members, and were used to develop recommendations.ResultsThe workgroup developed 12 recommendations to optimize impact of embedded researchers within health systems. The group highlighted the tension between "ROI vs. R01" goals-where health systems focus on achieving return on their investments (ROI) while embedded researchers focus on obtaining research funding (R01). Recommendations are targeted to three key stakeholder groups: researchers, funders, and health systems. Consensus for an ideal foundation to support optimal embedded research is one that (1) maximizes learning; (2) aligns goals across all 3 stakeholders; and (3) implements EBIs in a consistent and timely fashion.ConclusionsFour cases illustrate a variety of ways that embedded research can be structured and conducted within systems, by demonstrating key embedded research values to enable collaborations with academic affiliates to generate actionable knowledge and meaningfully accelerate implementation of EBIs to benefit patients.ImplicationsEmbedded research approaches have potential for transforming health systems and impacting patient health. Accelerating embedded research should be a focused priority for funding agencies to maximize a collective return on investment